Since 1981, Parents as Teachers has delivered evidence-based family support services through in-home visits. Operating in all 50 states, the organization works to promote the optimal early development, learning, and health of children by offering support to parents. Recognizing that parents are a child's first and most important teacher, its aim is to partner with parents, providing them with practical tools and resources.

Now, by teaming up with the University of Southern California (USC), the organization's services are being expanded to an online format. In partnership with the USC Suzanne Dworak-Peck School of Social Work, Parents as Teachers has launched a pilot project to provide parent education and family support services virtually, utilizing the university's telehealth platform. Both partners are excited about the potential to reach even more families, particularly high-need, hard-to-reach families in underserved communities.

Angela Rau, virtual parenting education coordinator with Parents as Teachers, shares how they seek to bring out the best in both the parent and the child. "We believe in the abilities of parents," Rau says, "and we believe in lifting up those abilities and seeking a partnership with the family." Regarding the pilot project, she says, "We want to look at what kind of technology can enhance the relationship to really be efficacious in building that partnership."

Virtual Service Delivery
For the project, graduate fellows from the USC Suzanne Dworak-Peck School of Social Work receive training in the Parents as Teachers service model. Program services are delivered through USC Telehealth, a virtual counseling and therapy clinic. Where needed, participating families are provided with tablets and wireless internet access for the project term to enable their participation in live, web-based videoconference sessions. Other service components, such as child health and development screenings, community support referrals, and group gatherings with other parents, are also provided virtually.

Dorian Traube, PhD, an associate professor and associate dean of faculty affairs at USC Suzanne Dworak-Peck School of Social Work, is the pilot project's lead investigator. She explains that up until now, technology has been used primarily to support communications and activities between home visits. For instance, a parent might be provided with some online materials or videos to view at their convenience.

What makes this pilot program so unique is the fact that the full range of support services are being delivered in a virtual format with live, real-time parent-provider interaction throughout. "The key thing about this project," Traube says, "is that we've taken a nationwide evidence-based program and we're delivering it entirely through an online platform."

Parents Embrace Program
From its inception, Parents as Teachers has provided home-based visits to families. "When we first came about," Rau says, "we wanted to go to families where they were at, and that was in their home." But with the expansion of technology and online communications over the past two decades, today's parents have grown comfortable receiving services in a variety of virtual formats. Online communication is now embraced and increasingly expected.

According to Rau, parents are communicating their receptiveness to online services by, for example, requesting to get in touch via text messages. "We're seeing a transformation in our culture," she says. "[Technology] is seeping into our daily way of life. It's becoming a norm and we don't even think twice about it. We in the helping professions want to keep up with that so we can continue to meet people where they're at."

Traube also sees a growing comfort level with online communication and virtual services. "Parents are really receptive to receiving services in this way," she says. "The majority of parents are already engaging with technology regularly. They're often utilizing internet technologies on a daily basis." She cites examples such as online Skype calls with family members, checking e-mail daily, and using social media. In addition, she notes that parents are looking for child care information online.

On-Site Home Visits
Coordinating on-site home visits presents a number of logistical and scheduling challenges. "It can be challenging to get to some of the more rural areas," Rau explains, "due to distance and transportation issues." She adds that getting to parents living in urban areas can be difficult as well, due to issues like traffic congestion.

Parents' work schedules can also pose a challenge when trying to coordinate on-site visits. Parents might be working multiple part-time jobs or doing shift work; their availability might be sporadic as a result.

Personal preferences and individual comfort levels can also present a barrier to in-home visits. "There's a subset of the population that feels uncomfortable having a service provider come into their home on a regular basis," Traube says. In all of these situations, families benefit from the ease and convenience that virtual service delivery affords.

Developmental Screening, Early Intervention
Preventive care, developmental screening, and early intervention are core components of effective child care and development, and the ability to offer services virtually has promising implications in these areas. "Early screening helps parents to know where their child is at in development," Rau says, "and it affords an opportunity to offer some effective parenting strategies."

The reality, however, is that a number of families are not accessing the screening options currently available. Rau says, "Virtual parent support services provide an opportunity for us to consider other ways to deliver screenings," increasing the potential to reach more families during this critical time in their child's development.

We know that if you can intervene with children when they're young, you can prevent issues down the road," says Traube, further highlighting the importance of such early intervention. "Developmentally, 80% of a child's brain is formed during the period from birth to three years of age. So this is the optimal time to be providing intervention services."

Improving Service Delivery
Rau is excited at the potential that virtual service delivery offers for reaching more families, especially those that might otherwise struggle to access support services. But she emphasizes the need to ensure that technology is used effectively. She cites important questions that need to be answered in order to make informed program planning decisions: "How do we use technology to recruit families? How do we use technology to provide supervision? How do we use technology to provide timely resources to parents and build relationships with them, without being intrusive in their routine?"

Going forward, Rau underscores the importance of not just pushing to adopt technology blindly, but doing so in a strategic fashion. "We need to know what is effective," she says. "Then we can inform our funders and partners about the technology-based options that lead to strong outcomes, and we can weave those approaches into our service delivery and into our communities."

A strategic approach is also needed precisely because of the expansion of technology and online communications previously mentioned. "Parents are inundated with apps right now," Rau says. "We need to find the best way to get the information to them that's going to stick." She adds, "We can't afford to have multiple apps that don't work. We need to find out what works so we can make a case to our funders and use our money effectively."

Increased Capacity, Lowered Costs, Scalability
In addition to the aforementioned benefits to families, Traube points out that virtual service delivery provides other concrete, measurable benefits. There's the obvious capacity gain of increased access to services across communities, as virtual services have the ability to reach people regardless of location.

Financially, these services provide a lower cost alternative to traditional on-site services. Delivering services virtually, Traube says, requires only one-half of what it costs to deliver those same services on the ground.

Virtual services are also much more scalable than on-site service delivery. "When you deliver in-person services," Traube explains, "there's an upper threshold of how many people you can serve, both in terms of how many home parent educators you can employ to provide those services, and in terms of the client population you can reach out to." Virtual service delivery allows a program to maximize resources and that upper threshold increases significantly.

Next Step In Home Visitation
Traube anticipates that this project and the virtual format it utilizes will have far-reaching impact for parent education and family support services. She explains that currently, the only evidence-based research findings for parent support programs are drawn from on-site home-based services. The findings from this project will be valuable in shedding light on how virtual visitation programs can be implemented more widely using telehealth technology.

"This is the next step in home visitation," Traube says. "It will allow us to reach more families; and it will allow us to move forward in providing universal access to home visitation services."

More broadly, Traube believes this project reflects the future direction of social work practice, as behavioral care service providers consider how they can deliver a broader range of services remotely using virtual platforms. "The future of behavioral health service provision," she says, "is through telehealth and telemedicine."

Rau agrees with this assessment. "Telehealth is growing exponentially," she says. "The health field is showing strong outcomes. People are asking for these [virtual] services." She believes the increased use of technology for service delivery in future is inevitable. "It's going to happen, so we need to learn the best strategies to use when delivering services over an online platform."

— Susan A. Knight works with organizations in the social services sector to help them get the most out of their client management software.